Provider Demographics
NPI: | 1124991054 |
---|---|
Name: | THERAPHYSICAL LLC |
Entity type: | Organization |
Organization Name: | THERAPHYSICAL LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MAGDALENA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BUCZEK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 973-277-3911 |
Mailing Address - Street 1: | 623 RIDGE ROAD |
Mailing Address - Street 2: | |
Mailing Address - City: | LYNDHURST |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07071 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-340-4656 |
Mailing Address - Fax: | 201-340-4580 |
Practice Address - Street 1: | 1030 MCBRIDE AVE |
Practice Address - Street 2: | |
Practice Address - City: | WOODLAND PARK |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07424 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-339-9913 |
Practice Address - Fax: | 973-339-9914 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | THERAPHYSICAL LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2025-09-26 |
Last Update Date: | 2025-09-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |